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Korean Journal of Radiology 2016To compare the multidetector CT (MDCT) features of malignant pleural mesothelioma (MPM) and metastatic pleural disease (MPD).
OBJECTIVE
To compare the multidetector CT (MDCT) features of malignant pleural mesothelioma (MPM) and metastatic pleural disease (MPD).
MATERIALS AND METHODS
The authors reviewed the MDCT images of 167 patients, 103 patients with MPM and 64 patients with MPD. All 167 cases were pathologically confirmed by sonography-guided needle biopsy of pleura, thoracoscopic pleural biopsy, or open thoracotomy. CT features were evaluated with respect to pleural effusion, pleural thickening, invasion of other organs, lung abnormality, lymphadenopathy, mediastinal shifting, thoracic volume decrease, asbestosis, and the presence of pleural plaque.
RESULTS
Pleural thickening was the most common CT finding in MPM (96.1%) and MPD (93.8%). Circumferential pleural thickening (31.1% vs. 10.9%, odds ratio [OR] 3.670), thickening of fissural pleura (83.5% vs. 67.2%, OR 2.471), thickening of diaphragmatic pleura (90.3% vs. 73.4%, OR 3.364), pleural mass (38.8% vs. 23.4%, OR 2.074), pericardial involvement (56.3% vs. 20.3%, OR 5.056), and pleural plaque (66.0% vs. 21.9%, OR 6.939) were more frequently seen in MPM than in MPD. On the other hand, nodular pleural thickening (59.2% vs. 76.6%, OR 0.445), hilar lymph node metastasis (5.8% vs. 20.3%, OR 0.243), mediastinal lymph node metastasis (10.7% vs. 37.5%, OR 0.199), and hematogenous lung metastasis (9.7% vs. 29.2%, OR 0.261) were less frequent in MPM than in MPD. When we analyzed MPD from extrathoracic malignancy (EMPD) separately and compared them to MPM, circumferential pleural thickening, thickening of interlobar fissure, pericardial involvement and presence of pleural plaque were significant findings indicating MPM than EMPD. MPM had significantly lower occurrence of hematogenous lung metastasis, as compared with EMPD.
CONCLUSION
Awareness of frequent and infrequent CT findings could aid in distinguishing MPM from MPD.
Topics: Adult; Aged; Diagnosis, Differential; Female; Humans; Image-Guided Biopsy; Lung Neoplasms; Lymphatic Metastasis; Male; Mesothelioma; Mesothelioma, Malignant; Middle Aged; Multidetector Computed Tomography; Odds Ratio; Pleural Neoplasms; Republic of Korea; Retrospective Studies
PubMed: 27390546
DOI: 10.3348/kjr.2016.17.4.545 -
Advances in Respiratory Medicine 2019Pleural biopsy is the commonest mode of obtaining thoracoscopic pleural specimens from suspected pleural lesions. However, this may be associated with arisk of bleeding...
INTRODUCTION
Pleural biopsy is the commonest mode of obtaining thoracoscopic pleural specimens from suspected pleural lesions. However, this may be associated with arisk of bleeding in certain cases. The decision to perform biopsy could be difficult, especially when the lesions are close to vascular structures and the visceral pleura. So, pleural brushing can be used to get safely thoracoscopic specimens in addition to biopsy samples.
AIM
To determine the sensitivity and specificity of thoracoscopic pleural brushing in exudative pleural effusions.
MATERIAL AND METHODS
This prospective study was done in the Department of Pulmonary Medicine, Sri Manakula Vinayagar Medical College, Pondicherry, India on 80 patients with exudative pleural effusion in whom pleural fluid analysis and closed pleu-ral biopsy results were inconclusive. All these patients were subjected to medical thoracoscopy after getting informed consent. Pleural biopsy and pleural brushings were taken and sent for analysis.
RESULTS
Thoracoscopic pleural biopsy was diagnostic in 76 of 80 patients (95%). Thoracoscopic pleural brushing was diagnostic in 74 patients (92.5%). Histopathology revealed malignancy (82.7%), granulomatous inflammation (11.5%) and nonspecific inflam-mation (5.7%). The sensitivity and specificity of pleural brushing were 96% and 75%, respectively. Interestingly, pleural brushing was the only diagnostic modality in one patient that was reported to be adenocarcinoma.
CONCLUSIONS
Thoracoscopic pleural brushing is an easy, convenient and safe procedure as it can augment the diagnostic yield of thoracoscopy. It is of significant value, especially in sampling pleural lesions close to vessels and the visceral pleura compared to pleural biopsy.
Topics: Adult; Female; Humans; India; Male; Middle Aged; Pleura; Pleural Diseases; Pleural Effusion; Prospective Studies; Specimen Handling; Thoracoscopy; Tuberculosis, Pleural
PubMed: 31680224
DOI: 10.5603/ARM.2019.0046 -
Thorax Feb 2022Familial spontaneous pneumothorax (FSP) accounts for 10% of primary spontaneous pneumothoraces. Appropriate investigation of FSP enables early diagnosis of serious...
Familial spontaneous pneumothorax (FSP) accounts for 10% of primary spontaneous pneumothoraces. Appropriate investigation of FSP enables early diagnosis of serious monogenic diseases and the practice of precision medicine. Here, we show that a pneumothorax genetics multidisciplinary team (MDT) can efficiently diagnose a range of syndromic causes of FSP. A sizeable group (73.6%) of clinically unclassifiable FSPs remains. Using whole genome sequencing we demonstrate that most of these cases are not known monogenic disorders. Therefore, clinico-radiological assessment by an MDT has high sensitivity for currently known clinically important monogenic causes of FSP, which has relevance for the design of efficient pneumothorax services.
Topics: Humans; Pneumothorax; Precision Medicine
PubMed: 34145047
DOI: 10.1136/thoraxjnl-2021-217210 -
BMC Pulmonary Medicine Oct 2022Major advances in management of common pleural diseases have taken place in the past decade. However, pleural diseases are often managed by physicians of diverse...
BACKGROUND
Major advances in management of common pleural diseases have taken place in the past decade. However, pleural diseases are often managed by physicians of diverse training background and research on implementation of new knowledge is scanty. We aim to evaluate the practice pattern in pleural medicine among physicians in Hong Kong, for identification of possible gaps for clinical service improvement.
METHODS
The Hong Kong Thoracic Society undertook a cross-sectional questionnaire survey in 2019, targeting clinicians of various subspecialties in internal medicine and levels of experience (basic and higher trainees, specialists) from twelve regional hospitals of diverse service scopes throughout Hong Kong. Respondents were selected by non-probability quota sampling. The questionnaire tool consisted of 46 questions covering diagnostic and therapeutic aspects of common pleural diseases. The responses were anonymous, and analysed independently using SPSS statistics software.
RESULTS
The survey collected 129 responses, 47(36%) were from clinicians specialized in respiratory medicine. Majority of the respondents (98%) managed pleural diseases, including performing pleural procedures in their practice. Fifty-five percent of all the respondents had not received any formal training in transthoracic ultrasonography. A significant proportion of clinicians were unaware of pleuroscopy for investigation of exudative pleural effusion, indwelling pleural catheter for recurrent malignant pleural effusion, and combined intra-pleural Alteplase plus DNase for treatment of pleural infection (30%, 15% and 70% of non-respiratory clinicians respectively). Significant heterogeneity was found in the management of pleural infection, malignant pleural effusion and pneumothorax among respiratory versus non-respiratory clinicians. Contributing factors to the observed heterogeneity included lack of awareness or training, limited accessibility of drugs, devices, or dedicated service support.
CONCLUSION
Significant heterogeneity in management of pleural diseases was observed among medical clinicians in Hong Kong. Continuous medical education and training provision for both specialists and non-specialists has to be strengthened to enhance the implementation of advances, improve quality and equity of healthcare provision in pleural medicine.
Topics: Humans; Pleural Effusion, Malignant; Cross-Sectional Studies; Hong Kong; Tissue Plasminogen Activator; Surveys and Questionnaires; Pleural Diseases; Deoxyribonucleases
PubMed: 36280817
DOI: 10.1186/s12890-022-02196-4 -
Clinical Medicine (London, England) Oct 2013Pleural disease is increasingly recognised as an important subspecialty within respiratory medicine, especially as cases of pleural disease continue to rise...
Pleural disease is increasingly recognised as an important subspecialty within respiratory medicine, especially as cases of pleural disease continue to rise internationally. Recent advances have seen an expansion in the options available for managing patients with pleural disease, with access to local-anaesthetic thoracoscopy, indwelling pleural catheters and thoracic ultrasound all becoming commonplace. Pleural teams usually consist of a range of practitioners who can optimise the use of specialist services to ensure that patients with all types of pleural disease - who have traditionally needed extended admissions - are managed efficiently, often entirely as outpatients. A pleural service can also provide improved opportunities for enhancing procedural skills, engaging in clinical research, and reducing the costs of care. This article explores the justification for dedicated pleural services and teams, as well as highlighting the various roles of hospital personnel who might be most useful in ensuring their success.
Topics: Health Services Needs and Demand; Humans; Patient Care Team; Pleural Diseases; Specialization; United Kingdom
PubMed: 24115700
DOI: 10.7861/clinmedicine.13-5-452 -
Respirology (Carlton, Vic.) Jul 2016
Topics: Catheters, Indwelling; Humans; Pleural Effusion, Malignant; Pleural Neoplasms
PubMed: 27222077
DOI: 10.1111/resp.12822 -
Respirology (Carlton, Vic.) May 2015
Review
Topics: Bronchoscopy; Combined Modality Therapy; Diagnostic Imaging; Humans; Japan; Lung Neoplasms; Morbidity; Pleural Diseases; Respiratory Tract Infections; Tuberculosis
PubMed: 25736820
DOI: 10.1111/resp.12502 -
PloS One 2021Evacuation of infected fluid in pleural infections is essential. To date, the use of an intrapleural fibrinolytic agent such as urokinase and DNase has not yet been... (Comparative Study)
Comparative Study
INTRODUCTION
Evacuation of infected fluid in pleural infections is essential. To date, the use of an intrapleural fibrinolytic agent such as urokinase and DNase has not yet been assessed in infections managed by repeated therapeutic thoracentesis (RTT).
METHODS
We performed a retrospective comparative study of two successive cohorts of consecutive patients with pleural infections from 2001 to 2018. Between 2001 and 2010, patients had RTT with intrapleural urokinase (RTT-U). After 2011, patients received intrapleural urokinase and DNase with RTT (RTT-UD). Data were collected through a standardized questionnaire.
RESULTS
One hundred and thirty-three patients were included: 93 were men and the mean age was 59 years (standard deviation 17.2). Eighty-one patients were treated with a combination of intrapleural urokinase and DNase, and 52 were treated with intrapleural urokinase only. In the RTT-UD, RTT failure occurred in 14 patients (17%) compared to 10 (19%) in the RTT-U group (P = 0.82). There was no difference between the two groups in intensive care unit admission, surgical referrals or in-hospital mortality. RTT-UD was associated with faster time to apyrexia (aOR = 0.51, 95%CI [0.37-0.72]), a reduced length of hospital stay (aOR = 0.61, 95%CI [0.52-0.73]) and a higher volume of total pleural fluid retrieved (aOR = 1.38, 95%CI [1.02-1.88]). Complications were rare with only one hemothorax in the RTT-UD group and no pneumothorax requiring drainage in either group.
CONCLUSION
Compared to urokinase only, intrapleural use of urokinase and DNase in RTT was associated with quicker defervescence, shorter hospital stay and increased volumes of pleural fluid drained. Randomized controlled trials evaluating urokinase and DNase with RTT technique would be required to confirm these results.
Topics: Adult; Aged; Deoxyribonucleases; Disease-Free Survival; Drainage; Empyema, Pleural; Female; Humans; Male; Middle Aged; Pleura; Pleural Diseases; Pleural Effusion; Pneumothorax; Retrospective Studies; Surveys and Questionnaires; Thoracentesis; Urokinase-Type Plasminogen Activator
PubMed: 34547022
DOI: 10.1371/journal.pone.0257339 -
British Journal of Industrial Medicine Feb 1992The aim of this study was to describe a scoring system for high resolution computed tomographic (HRCT) scans analogous to the International Labour Office (ILO) scoring...
The aim of this study was to describe a scoring system for high resolution computed tomographic (HRCT) scans analogous to the International Labour Office (ILO) scoring system for plain chest radiographs in patients with asbestos related disease. Interstitial fibrosis, pleural disease, and emphysema were scored, the reproducibility and the interobserver agreement using this scoring system were examined, and the extent of the various types of disease was correlated with measurements of lung function. Sixty asbestos workers (five women and 55 men) mean age 59 (range 34-78) were studied. The lungs were divided into upper, middle, and lower thirds. An HRCT score for the extent of pleural disease and pulmonary disease in each third was recorded in a way analogous to the International Labour Office (ILO) method of scoring pleural and parenchymal disease on chest radiographs. A CT score for the extent of emphysema was also recorded. Pleural disease and interstitial fibrosis on the plain chest radiographs were assessed according to the ILO scoring system. A chest radiographic score for emphysema analogous to that used for HRCT was also recorded. Two independent readers assigned HRCT scores that differed by two categories or less in 96%, 92%, and 85% compared with 90%, 78%, and 79% of cases for chest radiographs for fibrosis, emphysema, and pleural disease respectively. There was better intraobserver repeatability for the HRCT scores than for the chest radiograph scores for all disorders. Multiple regression analysis showed that scores for interstitial fibrosis, emphysema, and pleural disease on chest radiographs and HRCT correlated to a similar degree with impairment of lung function.
Topics: Adult; Aged; Asbestosis; Female; Humans; Male; Middle Aged; Observer Variation; Occupational Diseases; Pleural Diseases; Pulmonary Emphysema; Pulmonary Fibrosis; Reproducibility of Results; Respiratory Function Tests; Severity of Illness Index; Tomography, X-Ray Computed
PubMed: 1536823
DOI: 10.1136/oem.49.2.73 -
The Journal of International Medical... Apr 2024Bronchopleural fistula (BPF) is a potentially fatal complication and remains a surgical challenge. Concomitant problems, such as pulmonary infection and respiratory...
Bronchopleural fistula (BPF) is a potentially fatal complication and remains a surgical challenge. Concomitant problems, such as pulmonary infection and respiratory failure, are typically the main contributors to mortality from BPF because of improper contact between the bronchial and pleural cavity. We present the case of a 75-year-old male patient with a history of right upper lobe lung cancer resection who developed complex BPFs. Following appropriate antibiotic therapy and chest tube drainage, we treated the fistulas using endobronchial valve EBV placement and local argon gas spray stimulation. Bronchoscopic treatment is the preferred method for patients who cannot tolerate a second surgery because it can help to maximize their quality of life. Our treatment method may be a useful reference for treating complex BPF.
Topics: Male; Humans; Aged; Quality of Life; Bronchoscopy; Bronchial Fistula; Pleural Diseases; Anti-Bacterial Agents
PubMed: 38635897
DOI: 10.1177/03000605241245269